34 STANDING COMMITTEE ON DEFENCE (2016-2017) (SIXTEENTH LOK SABHA) MINISTRY OF DEFENCE PROVISION OF MEDICAL SERVICES TO ARMED FORCES INCLUDING DENTAL SERVICES THIRTY FOURTH REPORT LOK SABHA SECRETARIAT NEW DELHI August, 2017 / Shravana, 1939 (Saka) THIRTY FOURTH REPORT STANDING COMMITTEE ON DEFENCE (2016-2017) (SIXTEENTH LOK SABHA) MINISTRY OF DEFENCE PROVISION OF MEDICAL SERVICES TO ARMED FORCES INCLUDING DENTAL SERVICES Presented to Lok Sabha on 10 .08. 2017 Laid in Rajya Sabha on 09.08. 2017 LOK SABHA SECRETARIAT NEW DELHI August, 2017 / Shravana, 1939 (Saka) CONTENTS PAGE COMPOSITION OF THE COMMITTEE (2016-17)…………………………….. INTRODUCTION ………………………………………………………………….. REPORT PART I Chapter I Introduction Chapter II Role And Responsibilities of AFMS Chapter III Manpower Chapter IV Modernization and Infrastructure Upgradation Chapter V Funding Chapter VI Alternate Medicine Chapter VII Preparedness For Nuclear, Biological and Chemical War Chapter VIII Training Chapter IX Armed Forces Medical College Chapter X Artificial Limb Centre Chapter XI Medicines And Medical Stores Chapter XII Disaster Management Chapter XIII Contagious Diseases Chapter XIV Digitization Chapter XV Research and Development PART II Observations/Recommendations APPENDICES Minutes of the Sitting of the Standing Committee on Defence (2016-17) held on 17.06.2016, 25.05.2017 and 02.08.2017………………………………………………. COMPOSITION OF THE STANDING COMMITTEE ON DEFENCE ( 2016-17 ) Maj Gen B C Khanduri, AVSM (Retd) - Chairperson Lok Sabha 2. Shri Dipak Adhikari (Dev) 3. Shri Suresh C Angadi 4. Shri Shrirang Appa Barne 5. Shri Thupstan Chhewang 6. Col Sonaram Choudhary(Retd) 7. Shri H D Devegowda 8. Shri Sher Singh Ghubaya 9.* Shri B. Senguttuvan 10. Dr Murli Manohar Joshi 11. Km Shobha Karandlaje 12.♦ Shri Vinod Khanna 13. Dr Mriganka Mahato 14. Shri Rodmal Nagar 15. Shri A P Jithender Reddy 16. Shri Ch Malla Reddy 17.+ Shri Rajeev Shankarrao Satav 18. Smt Mala Rajya Lakshmi Shah 19.# Shri Partha Pratim Ray 20. Shri Dharambir Singh 21. Smt Pratyusha Rajeshwari Singh 22.** Shri G Hari 23.$ Capt Amarinder Singh 24.♠ Shri Gaurav Gogoi Rajya Sabha 1. Shri K R Arjunan 2. Shri A U Singh Deo 3. Shri Harivansh 4.^ Shri Rajeev Chandrasekhar 5. Shri Madhusudan Mistry 6. Shri Praful Patel 7. Shri Sanjay Raut 8. Dr Abhishek Manu Singhvi 9. Smt Ambika Soni 10. Dr Subramanian Swamy 11.@ Shri Om Prakash Mathur * Nominated w.e.f on 13.02.2017 ** Ceased to be Member of the Committee w.e.f. 13.02.2017 $ Ceased to be Member of the Committee w.e.f. 23.11.2016 # Nominated w.e.f. 02.01.2017 @ Ceased to be Member of the Committee w.e.f. 10.10.2016 ^ Nominated w.e.f. 10.10.2016 ♠ Nominated w.e.f. 28.03.2017 ♦ Sad Demise of Member on 27.04.2017 + Ceased to be Member of the Committee w.e.f. 28.03.2017 SECRETARIAT 1 Smt Kalpana Sharma - Joint Secretary 2 Shri T G Chandrasekhar - Director 3 Smt Jyochnamayi Sinha - Additional Director 4 Smt Rekha Sinha - Sr. Executive Assistant INTRODUCTION I, the Chairperson of the Standing Committee on Defence (2016-17), having been authorised by the Committee, present this Thirty-Fourth Report on 'Provision of Medical Services to Armed Forces including Dental Services'. 2. The subject 'Provision of Medical Services to Armed Forces including Dental Services' was selected for examination during the year 2016-17. The Committee took evidence of the representatives of the Ministry of Defence and Department of Armed Forces Medical Services on 17.06.2016 and 25.05.2017. The draft Report was considered and adopted by the Committee at their Sitting held on 02 August, 2017. 3. The Committee wish to express their thanks to the officials of the Ministry of Defence, Armed Forces Medical College(AFMC), Pune and Artificial Limb Centre(ALC), Pune for furnishing the requisite material and information which were desired in connection with examination of the subject. 4. For facility of reference and convenience, Observations/Recommendations of the Committee have been printed in bold letters in Part II of the Report. New Delhi; MAJ GEN B C KHANDURI, AVSM (RETD) 04 August, 2017 Chairperson 13 Shravana, 1939(Saka) Standing Committee on Defence REPORT PART- I Introductory Armed Forces Medical Services (AFMS) is an inter services organization headed by the Director General Armed Forces Medical Services (DGAFMS) who functions directly under the Ministry of Defence. It is responsible for providing health care services to Armed Forces personnel, their families and other beneficiaries as mandated. The present shape and structure of the AFMS was given by the Armed Forces Medical Services and Research Integration committee chaired by Dr BC Roy in 1948. Based on the recommendations of this committee the Government of India integrated the Medical Services of the Army, Navy, and Air Force and created the appointment of DGAFMS on 18 August, 1948 in the rank of Lt Gen and equivalent. The Director General, Armed Forces Medical Services is the Medical Adviser to the Ministry of Defence and is also the Chairman of the Medical Services Advisory Committee (MSAC). Also, the DGAFMS is the cadre controlling authority for the AFMS. Structure 1.2. The medical components of the three wings of the Armed forces have their Medical Directorates headed by the Director General Medical Services (DGMS) in the rank of Lt Gen (& equivalent). The DGsMS function under their respective Service Chief in matters of day to day administration, operational commitments and logistics and are responsible for the day to day administration and proper functioning of the Service under them. Any matter with inter services bearing is referred to the DGAFMS. Coordination between the medical services of the three wings of the Armed Forces as well as the DGAFMS is mediated through the Armed Forces Medical Services Advisory Committee (MSAC). The MSAC is chaired by the DGAFMS and has the DGMS (Army), DGMS(Navy), DGMS (Air) and the Director General Hospital Services (Armed Forces) (DGHS(AF)) as its members. 1.3. The Director General Dental Services (DGDS) and the Additional Director General Military Nursing Services (ADGMNS) are invited to attend meetings of MSAC when any aspect related to their respective Service is discussed. 1.4. The DGAFMS is the advisor to the Ministry of Defence (MoD) on all health issues of the Armed Forces. The primary responsibilities of DGAFMS include enunciation of policy on all medical matters of the Armed Forces, cadre management of the AMC, ADC and MNS, training of medical, nursing and paramedical personnel, medical research, provisioning and procurement of medical stores and equipment, and matters related to disability pensions of Armed Forces personnel.The personnel of the Armed Forces Medical Services (AFMS) consist of: - (a) Officers of the Army Medical Corps (AMC) including AMC non-technical officers, officers of the Army Dental Corps (AD Corps), Officers of the Military Nursing Services (MNS), AMC and AD Corps officers seconded to the Navy and the Air Force and probationer nurses. (b) Junior Commissioned Officers (JCOs), Other Rank (OR) and the AMC, Medical Assistants of the Navy and Medical Assistants of the Air Force. (c) Civilians of categories sanctioned periodically by the Government. Officers of the AMC are allotted to either the administrative or specialist cadre in accordance with terms and conditions sanctioned by the Government from time to time. Ranks 1.5. Medical Officers from the Armed Forces Medical College are commissioned as Lieutenant (and equivalent). On completion of internship training, they are promoted to the rank of Captain (and equivalent). Doctors from Medical Colleges other than AFMC are commissioned in the rank of Captain (and equivalent). All permanent commission Medical Officers are promoted to the rank of Major (and equivalent) and Lt Col (and equivalent) on the basis of time scale. They may then be promoted up to the rank of Lt General (and equivalent) on select grade basis. Dental Officers are commissioned as Captain (and equivalent). All permanent commission Dental Officers are promoted to the rank of Major (and equivalent) and Lt Col (and equivalent) on the basis of time scale. They may then be promoted up to the rank of Lt General (and equivalent) on select grade basis. The Medical Services Advisory Committee is responsible to the Chiefs of Staff Committee. It may make any recommendation on matters of medical organization or policy to the Government, through the Chiefs of Staff Committee. The MSAC will be responsible for the co-ordination of the overall medical policy of the Government, the implementation of which will be the responsibility of the Director Generals Medical Services (DGsMS) concerned. CHAPTER-II ROLE AND RESPONSIBILITIES OF AFMS The Primary role of Armed Forces Medical Services (AFMS) is to provide comprehensive health care including combat and operational medical support to the serving Armed Forces personnel, their families and dependents. 2.1 The AFMS was established to provide comprehensive health care to only the serving Armed Forces personnel and their families (wife and children) at the time of independence. Over the years, its role and responsibility have expanded considerably with its services having been extended to parents of service personnel (in 1965) Initially, field units consisted of medical battalions and all Command Hospitals had a training reserve. The AFMS cater to an ever increasing clientele. In 1962, the AMC catered to a clientele dependency of 20 lakhs. The total number of beds allotted to AFMS hospitals in 1965 were 24,996. During the corresponding period 3,353 Medical officers were held on the strength of AFMS. ( around 596 persons per doctor) As on 01 October 2016, the authorization of Medical Officers is 7,000, whereas the dependency is approx 2.5 crore for inpatient/outpatient care. This gives an average ratio of 01 doctor per 3961 dependent clientele.